This photo taken last month in San Juan, Puerto Rico, shows roofs damaged by Hurricane Maria and the interior of buildings still exposed to the elements.

Carlos Giusti
/ AP

An international human rights group, Refugees International, has issued a scathing report on the U.S. response in Puerto Rico to Hurricane Maria. The group says "poor coordination and logistics on the ground" by the Federal Emergency Management Agency and the Puerto Rican government "seriously undermined the effectiveness of the aid delivery process."

Refugees International is an independent non-profit group that advocates on behalf of displaced people around the world. This was the first time the group had investigated a situation in the U.S.

When its team arrived in Puerto Rico, more than two months after the storm, Refugees International says it was surprised that the relief effort was "uncoordinated and poorly implemented." The group says the poor response was "prolonging the humanitarian emergency on the ground."

Puerto Rico was especially vulnerable to a disaster like a hurricane, the group says, because of its aging population, poorly maintained infrastructure and lack of emergency management assets, like helicopters and backup generators. "In light of these known limitations," the report says, "it is troubling that it took five days before any senior federal official from the U.S. mainland visited the island."

Comparing it with past natural disasters, such as the 2010 Haitian earthquake, the group found the U.S. response lacking. In Haiti, the group says 8,000 U.S. troops were deployed to the island within two days of the disaster. In Puerto Rico, it took 10 days for 4,500 U.S. troops to arrive. Central to FEMA's problematic response, Refugees International says, is that the federal agency is designed to supplement local and state disaster response efforts. But in Puerto Rico, the group found, municipalities and the Commonwealth had "limited capacity and ability to respond."

Now that immediate needs like food and water are taken care of, the group says, Puerto Rico's greatest need is housing. Puerto Rico's government says more than 472,000 homes were destroyed or badly damaged in Hurricane Maria. Months after the storm, Refugees International says, housing assistance provided by FEMA and the Puerto Rican government is not reaching the most vulnerable populations. Authorities have failed to distribute tarps and temporary roofs to all who need them, the group says. And the process for receiving assistance is complicated, confusing and poorly executed.

Responding to the Refugees International report, FEMA agreed that coordination of efforts in disaster response is vital. But FEMA said Puerto Rico's devastation by the hurricane presented a difficult situation. "More than 1,000 nautical miles from the mainland United States with an already fragile infrastructure and facing challenging economic circumstances presented communication and logistical challenges unique to the situation."

FEMA said:

"We regret the loss of life after any disaster and our thoughts and prayers are with the family members affected by the devastation of Hurricane Maria. FEMA continues to work every day to bring back a sense of normalcy to Puerto Rico. ...

"Unity of effort is required for disaster response and recovery on any scale, but especially during this historic season. When emergency managers call for unity of effort, we mean that all levels of government, non-profit organizations, private sector businesses, and survivors must work together – each drawing upon their unique skills and capabilities – to meet the needs of disaster survivors."

Also Monday, Puerto Rico Gov. Ricardo Rossello announced he was ordering a review of all deaths in Puerto Rico following Hurricane Maria. Puerto Rico's government has listed the official death toll from the hurricane at just 64. Independent reporting from journalists and statistical analyses with past years suggest that more than 1,000 deaths may have been due to Hurricane Maria.

Rossello said by law in Puerto Rico, the cause of death must be certified by a doctor or coroner, something not always possible in the chaos after the storm. Rossello has ordered Puerto Rico's Demographic Registry and the Department of Public Safety to review all deaths to get "the most accurate count and understanding of how people lost their lives to fully account for the impact of these storms." The governor has also called for the creation of an expert panel to look at how deaths are certified and make suggestions on how to improve the process in the future.